Medications for GERD

The rationale for GERD treatment depends on a careful definition of specific aims. In patients without injury to the inner lining of the esophagus (esophagitis), the therapeutic goals are to relieve reflux symptoms and prevent further episodes of reflux. In patients with esophagitis, the goals are to relieve symptoms and heal esophagitis while preventing further relapses and complications.

When planning a management strategy for patients with GERD, it is important to appreciate that the efficacy of any antireflux therapy is inversely related to the severity of the underlying reflux esophagitis, i.e., the worse the esophagitis, the poorer the healing rate. The treatment that is highly effective for patients with mild esophagitis may be virtually useless for patients with severe disease. The ideal medication would be one that restores barrier function of the gastroesophageal junction. Unfortunately, at present there are no medications that are capable of doing this well.

Life style modifications

Although GERD is common, many sufferers do not seek medical care, instead choosing to change their lifestyles and self-medicate with OTC antacids, H2RAs, and even PPIs. The management of GERD traditionally begins with life-style modifications aimed at reducing acid reflux and minimizing the duration of contact between refluxed material and the esophageal mucosa.

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• The head of the bed is elevated on 4- to 6-inch blocks to exploit the effect of gravity in clearing the esophagus of noxious material
• Small frequent meals
• Going to bed 2- 3 hours after food
• Bedtime snacks should be avoided
• Obese patients are advised to lose weight
• Tobacco and alcohol consumption should be avoided
• Fatty foods, chocolate, and carminatives (spearmint, peppermint) contribute to GERD and should be avoided
• Drugs like NSAIDs, phenothiazines, tricyclic antidepressants, theophylline preparations, and calcium channel blocking agents
• Avoiding tight fitting clothes

Acid suppression therapy

Acid suppression remains the main pharmacological approach to the treatment of GERD. It is well documented that acid and pepsin are the predominant constituents of refluxed gastric juice that damage the esophageal mucosa. Over the counter medications are used in treating mild, infrequent heartburn symptoms, triggered by lifestyle indiscretions. The various medications that are available to treat are:

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• Antacids - Heartburn symptoms are rapidly relieved, but patients need to take antacids frequently, usually 1 to 3 hours after meals
• Gaviscon – It contains alginic acid and antacids, mixes with saliva to form a highly viscous solution acting as a mechanical barrier
• Prokinetic drugs - These drugs improve reflux symptoms by increasing LES pressure, acid clearance, and/or gastric emptying
• Histamine-2 Receptor Antagonists (H2RAs) - These drugs (cimetidine, ranitidine, famotidine, and nizatidine) are more effective in controlling nocturnal, as compared with meal-related acid secretion
• Proton Pump Inhibitors (PPIs) - PPIs inhibit meal-stimulated and nocturnal acid secretion to a significantly greater degree than H2RAs. PPIs (omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole) have superior efficacy compared with H2RAs.

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